Q.
What do you think will be the three most critical issues in the mental health field through the year 2010?

A.
It's not often I'm given the opportunity to prognosticate, if not pontificate--so here's my very subjective response to your interesting question. First, I'd separate the three most critical mental health care issues from the three most critical therapeutic/research issues in the mental health field, though these are clearly interrelated concerns. In terms of health care, I think the three top issues for the coming decade are (1) The allocation of mental health care within managed care settings; (2) The progress toward community placement and integration of the chronically mentally ill; and (3) The ongoing attempt to remove the stigma attached to mental illness, its victims and, yes, its treaters.

Of course, there are many other issues that come to mind, such as the need to protect the civil liberties and confidentiality of mental health patients (sometimes termed consumers, a term I find a bit too utilitarian). In terms of treatment and research issues, I would rank the top three as (1) The need to find more effective treatments for schizophrenia, including agents that treat the underlying pathophysiology, rather than merely the symptoms, of the illness; (2) The need for better recognition of bipolar depression, and the need for an effective antidepressant agent that does not worsen the course of bipolar disorder; and (3) the ongoing development of effective preventive treatments for dementia (particularly Alzheimer's Disease).

We are already taking great strides in these areas--witness the development of a potential vaccine for Alzheimer's Disease that is nearing the final stages of testing. Of course, many more challenges lie ahead.